Provider Demographics
NPI:1104819374
Name:JEFFREY, RONALD LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1773
Mailing Address - Street 2:
Mailing Address - City:MAPLE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98266-1773
Mailing Address - Country:US
Mailing Address - Phone:360-296-3507
Mailing Address - Fax:
Practice Address - Street 1:1401 EL NORTE PKWY
Practice Address - Street 2:#160
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1773
Practice Address - Country:US
Practice Address - Phone:360-296-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice